1Complete Solution

Emergency Room Visits 

Maternity Care (for pregnancies beginning after the plan membership effective date)

Q: Does 1Complete Solution include maternity benefits?

Yes,

Most of the larger expected maternity expenses will fall under the Sedera Health health sharing component.

Sedera has a very strong set of maternity benefits for expectant mothers and their children.

For 1Complete Solution members, normal vaginal deliveries and emergency Cesarean section deliveries for eligible maternity cases have a total Maternity Initial Unshareable Amount (Maternity IUA) of $3,000.

For pregnancies that have an expected delivery date within the first nine months of membership, the amount eligible for sharing for their maternity Needs Case from the pregnancy will be equal to the total Monthly Shares the Member has contributed from the beginning of their membership through the month of delivery.

Sharing in pre-existing pregnancies will only be available if the mother remains a Member through the birth of the child.

Women who are already pregnant may be better served with a traditional health insurance product that provides immediate benefits, though costs will be significantly higher without a subsidy, either from the Affordable Care Act premium tax credits or from their employers.

Q: Can I contribute to an HSA with 1Complete Solution?

Yes.

As long as the plan member is not covered by another health plan such as Medicaid or the VA, both employers and plan members can make pre-tax or tax-deductible contributions  to a health savings account, up to the annual limit set by Congress.

Q: Why Contribute to an HSA? 

Members who contribute to an HSA potentially save thousands in taxes and healthcare costs.

If you don’t need the money for healthcare costs, your assets in your HSA will compound tax-deferred indefinitely, for as long as the money stays in the account.

When you turn 65, you can withdraw your HSA money for any purpose – penalty free. You will just need to pay the income tax on the withdrawal, just as you would with other tax-deferred retirement accounts.

However, any withdrawals to pay for qualified medical expenses, including long term care and long term care insurance premiums, are still tax free.

There are no required minimum distributions, as there are with other tax-deferred retirement accounts. If you don’t need the money to live on, you can let your HSA money accrue indefinitely.

For these reasons, the HSA is arguably the most powerful savings tool available to U.S taxpayers. 

Q: What is the most that can be contributed to an HSA in a given year?

As of 2024, the annual contribution limit for HSAs is $4,150 for self-only coverage, and $8,300 for family coverage.

Those 55 and older can contribute an additional $1,000 as a catch-up contribution.

This amount is adjusted each year for inflation. 

Q: How does 1Complete Solution handle pre-existing conditions?

Sedera health, the catastrophic health sharing component of the 1Complete Solution plan, imposes a waiting period on certain pre-existing conditions. 

Q: Is there an income threshold restricting HSA contributions? 

No. Unlike IRAs, which restrict your ability to take a current year tax deduction on contributions, and Roth IRAs which restrict the ability of higher-income taxpayers to contribute at all, HSAs have no income caps on eligibility. You can make pre-tax or tax-deductible contributions to your HSA at any income level.

This makes HSAs a valuable savings vehicle for higher-income individuals. The higher your tax bracket, the more valuable the benefit. 

Q: Don’t employers who don’t offer a full ACA-qualified health insurance plan pay a penalty? 

Employers with fewer than 50 full-time equivalents are exempt from the penalty under the Affordable Care Act.

You can offer the 1Complete Solution plan instead of health insurance to any and all employees without having to pay a penalty.

Additionally, some larger employers are finding that the savings from dropping traditional group health products in favor of a health sharing plan more than compensate them for the ACA penalty. 

Q: Is there a religious requirement to join?  

 Neither 1Complete Solution nor Sedera Health impose a religious requirement for membership. 

However, members must attest that they will lead a healthy lifestyle, and not participate in illegal activities such as illegal substance abuse or drunk driving.

Q: Does 1Complete Solution accept smokers/tobacco users? 

 Yes.

1Complete Solution does not deny smokers or tobacco users. However, active tobacco users are subject to an additional surcharge of $75 per month.

Additionally, annual sharing limits for tobacco users are limited to $25,000 for the following conditions:

• COPD
• Heart disease
• Strokes
• Cancer

Q: How do you file a claim with 1Complete Solution? 

 Since Sedera Health is a health sharing plan, rather than a traditional health insurance company, they don’t use the “claim” terminology.

Instead, members with an eligible medical need submit a request for sharing to Sedera Health, along with proof of the medical expense.

You can do this by uploading a photo of your bill onto the Member portal.

At that point, Sedera staff will evaluate the need to ensure that it qualifies for sharing under the Member Guidelines.

 A Sedera medical bill negotiator may contact providers to discuss the appropriate payment for the services that were performed and determine if negotiations are necessary or available for the billed amounts.

Note: Because Members do not transfer risk to each other or to the Sedera Medical Cost Sharing Community, no request for sharing is ever guaranteed. Members always remain responsible for their medical expenses.

Q: Does 1Complete Solution share the cost for drug/alcohol addictions treatment?

Yes, up to $3,000 per needs case, via the Sedera health sharing platform. 

Q: Does 1Complete Solution share costs for chiropractic care? 

Yes, via the Sedera health sharing platform. 

Sharing for chiropractic services is limited to that medically necessary for treatment of a specific musculoskeletal injury or musculoskeletal disease for plan members age 18 and older.

Sharing is limited to $3,000 per Needs Case with a maximum of $3,000 per Membership Year, including related items for treating the musculoskeletal injury or musculoskeletal disease such as prescribed X-rays. 

Maintenance chiropractic treatment costs are not shareable.

Q: Does the plan help with psychiatric/mental health care costs? 

Yes, with limits, via the Sedera health sharing plan.

Inpatient psychiatric care and outpatient psychiatric care for the treatment for injuries and detectable organic agents causing cognitive disabilities are shareable up to $7,000 per separate Needs Case.

Prescribed psychotropic medications are shared as other prescription medications.

Other types of psychiatric care or services are shareable to a maximum of $3,000 per separate Needs Case when prescribed by a licensed medical provider.